THE BUZZ 2: Ill Wishes

JACKSON HOLE, WY – Over the past decade, Lisa Murphy-Weeks has confronted loss on several levels, the loss of her husband, her business. Through it all she’s remained unflappable, until a recent phone call to her senator’s office. She was speaking to Sen. Mike Enzi’s staff about the Better Care Reconciliation Act, the Senate health care bill that Enzi, along with Sen. John Barrasso and 11 other male senators, drafted behind closed doors.

“Anyone who knows me knows it takes a lot to break me and make me cry,” Murphy-Weeks wrote. “Senator Enzi’s office just did it.”

Murphy-Weeks says she was describing to a staffer the near million dollars in medical debt she and her late husband Darrel accrued following his ruptured brain aneurysm in 2004. Then, she said, the staffer hung up on her. Enzi’s office did not reply to PJH’s request for comment.

Although the family had health insurance, bills amassed quickly. A month at Eastern Idaho Regional Medical Center was more than $350,000.

After months of treatments and therapy, Darrel defied doctors’ prognoses—he was ready to return home. It was a miracle, albeit a costly one. For the next five years he and Murphy-Weeks navigated a mountain of escalating bills, incessant phone calls, and, ultimately, collections. Then in 2009 Darrel died from a heart attack. Murphy-Weeks was left to chip away at her late husband’s medical debt.

Now Murphy-Weeks, 52, wants to tell her story to anyone who will listen. Her message is that under BCRA her nightmare would become a reality for people who face catastrophic medical costs. That’s because BCRA would undo the provision under the Affordable Care Act that banned lifetime limits.

The Affordable Care Act prohibits insurance companies from placing a dollar limit on what they spend on a person’s health plan—private or through the marketplace.

Before ACA, patients were required to pay the cost of all care that exceeded their lifetime limit. Since Darrel became ill before ACA was enacted, he was among this group.

Because there were lifetime limits on the Weeks’s plan, medical debt enslaved them. They were forced to sell the family business and their credit was ravaged. Murphy-Weeks had to relinquish her insurance, and the insurance of her two teenage sons, to pay for Darrel’s. As property owners in Teton County, they could not file for bankruptcy.

“I lived through it for 12 years of my life and almost lost everything that I had worked for,” Murphy-Weeks told PJH. “We were just middle America small-town business owners with insurance. This could happen to anyone.”

In contrast to the Affordable Care Act, BCRA places decisions about lifetime limits into the hands of states. Experts say this is problematic. According to a Brookings Institution analysis by Matthew Fielder, states would need to meet only tenuous standards to obtain a waiver under the Senate bill. “The waivers,” he wrote, “could have wide-ranging implications for the extent and affordability of insurance coverage.”

States, then, could use this expanded waiver authority to eliminate the requirement that health plans cap annual out-of-pocket spending and the ban on individual and lifetime limits, Fielder noted. They could do this, he wrote, by setting a definition of “essential health benefits” that’s weaker than the definition under current law.

Groups hit hardest in Wyoming

Lifetime limits is not the only measure in the Senate health care bill stirring concern among Wyomingites. The Senate bill with deep cuts to Medicaid and tax breaks for the wealthy would disproportionately affect women in Wyoming, the state with the largest wage gap in the country.

According to U.S Census data, in 2015, full-time working women in Wyoming earned about 66 cents for every dollar a man earned. Before ACA, women in the state were grappling with another disparity: they were paying some of the highest premiums in the country in comparison to men.

A National Women’s Law Center 2016 report noted prior to the Affordable Care Act, women in Wyoming were charged as much as 41 percent more than men for the same coverage.

The Affordable Care Act eliminated gender rating, the practice of charging women different premiums than men, in the individual market. Prohibited under ACA, too, the report noted, is sex discrimination in health plans from insurance companies that receive federal funding or are involved with the federal government.

However, with the Senate health care bill, gender rating would likely return. Under BCRA there are no provisions to protect women from gender rating.

In states that have not banned gender rating—like Wyoming—more than 90 percent of best-selling plans were practicing the discriminatory measure before ACA became law, the NWLC report noted.

In addition to higher premiums, experts say women in Wyoming will be affected in other ways.

“Before ACA, most plans did not cover maternity services,” Eliot Fishman told PJH. He is the senior director of health policy at Families USA, a non-partisan organization that advocates for affordable health care in the U.S.

Today health care plans in Wyoming are required to cover maternity services. But this would likely change under the Senate bill, he said. That many low income expecting mothers rely on Medicaid for their maternity needs would also impact Wyoming women, Fishman noted.

Two other groups in Wyoming, Fishman said, which rely on Medicaid would also be disproportionately affected: veterans and children.

Under the Senate health care bill, 10 percent of Wyoming’s veterans, about 3,000 people, would lose their health insurance.

“People think the [Veterans Association] takes care of all veterans,” he said. “But it simply doesn’t have the resources to provide total care, so many have to depend on Medicaid.”

The number of Wyoming children who would lose insurance is staggering. About 9,000 children are uninsured in Wyoming. Under BCRA that number would spike to about 15,000 children, an increase of more than 70 percent.

It’s true that Wyoming is among the states that didn’t expand Medicaid under ACA. But some were hopeful it was moving in that direction. Governor Matt Mead, once a vociferous opponent of Medicaid expansion, has been urging the Wyoming legislature to expand Medicaid for the past two years. Now, providing coverage to Wyoming’s 31,000 uninsured adults eligible for Medicaid seems less likely.

“Wyoming was seriously considering Medicaid expansion, but [BCRA] forever takes that off the table,” Fishman said. “Under the ACA, Wyoming could have found a way to cover that [uninsured] population. This bill would foreclose that option.”

For many others, Fishman says the future is no more promising. “For people with incomes 350 percent above the poverty line ($41,000), for older people, and for people who have been purchasing silver level plans (the most common level), their premiums will all be going up.”

“The second component,” he continued, “is that deductibles will also be going up because federal government will be reducing the benchmark level of coverage that it subsidizes.” Out of pocket deductibles he said, would rise 40 percent.

According to the Congressional Budget Office, under BCRA by the year 2026, 23,500 people in Wyoming will lose Medicaid coverage and 25,600 will lose inidividual insurance.

(Un)cool kid on the block

Congress has delayed its vote on the bill until after its July Fourth recess, as a handful of Republican senators say they won’t support it as is. The bill has zero Democratic support. It’s even less popular with the public. According to at least one survey, BCRA has an approval rating hovering at 17 percent.

Patient, medical and insurance organizations have also decried the bill. The American Medical Association issued a statement last week that said the bill would undermine physicians’ ability to uphold the Hippocratic Oath which says doctors must “first, do no harm.”

“The draft legislation violates that standard on many levels,” the statement reads.

Barrasso, a physician himself and co-architect of the bill, did not respond to a request for comment about AMA’s statement.

Meanwhile, local health officials like St. John’s Hospital CEO Dr. Paul Beaupré are advising folks not to panic. He thinks the bill will evolve from its current state. He also emphasized St. John’s role in the community. “We would never turn someone away and have never done so in our 100 years,” he told PJH.

Still, he also noted Teton County—where an estimated 3,000 people could lose coverage—has the highest percentage of folks in the state insured under ACA, people like Murphy-Weeks.

For her arthritis and fibromyalgia, Murphy-Weeks takes prescription medication that, with insurance, costs almost $200 per month. If she lost her insurance, she said she would “have to decide each month whether to buy food or medicine.” PJH

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About Robyn Vincent

Robyn is the editor of Jackson Hole Snowboarder Magazine and former editor of Planet Jackson Hole. When she's not sweating deadlines, she likes to travel the world with her notebook and camera in hand. Follow her on Twitter @TheNomadicHeart